Portal thrombosis: late postoperative prevalence in Mansoni's schistosomiasis

Splenectomy with esophagogastric devascularization and distal splenorenal anastomosis are used for the treatment of bleeding esophageal varices in Mansoni's hepatosplenic schistosomiasis. Portal thrombosis followed by ascitis has been observed in the early postoperative phase, but there are no studies about the spontaneous and late postoperative prevalence of this vascular complication. The aim was to evaluate the spontaneous and late postoperative prevalence of total portal vein thrombosis and of ascitis in these patients.

US-Doppler examination was performed on 168 patients divided in three groups: 1) 92 non-operated (preoperative); 2) 62 after splenectomy with esophageal devascularization, 3) 14 after distal splenorenal anastomosis. The presence of ascitis was sought in all.

Group 1 had 5.43% (5/92) of spontaneous total portal vein thrombosis, groups 2 and 3, presented 19.35% (12/62) and 50.00% (7/14) in the late postoperative follow-up, respectively. The Fisher's test showed that group 3 had higher incidence of this vascular occlusive complication (p = 0.038). No ascites were found.

Surgical treatment of portal hypertension boosts the natural tendency to total portal vein thrombosis in this disease. The difference in the occurrence of this vascular complication during the late postoperative phase suggests the existence of a hemodynamic factor determined by the surgical technique.